CHILDREN AND YOUNG PEOPLES’ MENTAL HEALTH AND … · WELLBEING STRATEGY 2014-2017 Making the Mental Health and Emotional Wellbeing ... Child health and wellbeing is closely related

CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH AND EMOTIONAL WELLBEING STRATEGY 2014-2017Making the Mental Health and Emotional Wellbeing of Children and Young People ‘Everyone’s Business’

1 FOREWORD 4

2 RATIONALE 6

Introduction 6

Informing strategic direction 9

Underpinning principles (15)

3 ENSURING QUALITY AND GOVERNANCE 20

4 STAKEHOLDER ENGAGEMENT 22

5 AIMS 23

6 ACTION PLAN 24

REFERENCES

APPENDIX - Achievements 2010-2013

CONTENTS

2Children and young people’s mental health and emotional wellbeing strategy

Every individual who comes into contact with a child or young person has an affect on his or her mental health and emotional wellbeing. The vision of this strategy therefore is to ensure that ‘children and young people’s mental health and emotional wellbeing is Everyone’s Business’. Throughout this document you will find examples and information of why we need to do this.

This document follows and builds on the work of previous strategies aimed at developing the mental health and emotional wellbeing of children, young people, and their families in Liverpool. During the last 10 years Liverpool has taken an integrated and partnership approach to both commissioning and strategically developing children and young people’s mental health and emotional wellbeing services with the aim of making it everybody’s business. This partnership approach has continued during the few years including; following the change in Government which included large scale health reforms, the emergence of Clinical Commissioning Groups (CCG) and changes to local authority funding and structures.

The strategy is steered through the Children and Young People’s Mental Health and Emotional Wellbeing (MHEWB) Partnership Board who recognise that in order for positive mental health and wellbeing to exist in adults, the foundations need to be laid in childhood. The strategy will focus on the progress made within the last 10 years, as well as the range of interventions delivered to support CYP and their families by many different organisations including the voluntary and statutory sector.

This approach has enabled the Children and Young People’s MHEWB Partnership Board to promote the broader meaning of mental health and emotional wellbeing and understand the social determinants that affect mental wellbeing in addition to recognising the need for more evidence based therapeutic interventions for those children, young people and families who experience mental illness.

This strategy will support local and national policies and guidance including: § The Health and Social Care Act (2012) § Mental Health strategy: ‘No Health without Mental Health’ (2011) § Closing the gap: priorities for essential change in mental health (2014) § Public Health Outcomes framework (2013) § Children and Young People’s Health Outcomes (2013) § Children and Families Act (2014) § Public Service Social Value Act (2012) § Child Poverty strategy (2011) § Liverpool Primary Mental Health Care strategy for adults (2014) § Health and Wellbeing Strategy (2012) § Neglect strategy (2014) § Integrated Early Help strategy (2014) § Children and Young People’s Plan (2013)

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MENTAL HEALTH IS AS IMPORTANT AS PHYSICAL HEALTH. AS ONE YOUNG PERSON PUT IT: “IT DOESN’T MEAN BEING HAPPY ALL THE TIME, BUT IT DOES MEAN BEING ABLE TO COPE WITH THINGS.” (CAMHS REVIEW, 2008)

1 FOREWORD

It will support and promote the ‘Whole Family’ and Early Help model currently being implemented in Liverpool which aims to deliver high quality services for families by taking a multi-agency, integrated approach and working across both child and adult services to achieve better outcomes for families.

The Mental Health and Emotional Wellbeing Partnership Board have agreed the following outcomes for Liverpool in partnership with a number of stakeholders including children, young people and families: § Improved mental health of children, young people and their families § Improved environments so that children, young people and families can thrive § Increased Identification of children and young people with early indicators of distress and risk § Reduction in mild to moderate distress § Reduction in the development of moderate to severe distress § Reduction in life long distress

By working together, we hope to achieve these outcomes for children, young people and their families in Liverpool.

Dr Simon BowersGPCo-Chair Liverpool Children’s Trust BoardClinical Vice Chair & Children’s Lead, Liverpool CCG

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Liverpool Clinical Commissioning Group

Liverpool City Council

Liverpool Learning Partnership

Liverpool Schools and academies

Young Persons Advisory Service (YPAS)

Merseyside Youth Association (MYA)

Barnardos Young Carers

PSS Spinning World

Alder Hey Children’s NHS Foundation Trust

ADHD Foundation

Adult IAPT Addvanced Solutions

Mersey Care

Liverpool Community Health

Liverpool Women’s NHS Foundation Hospital

Commissioning Partners

Provider Partners

Children and young people’s mental health and emotional wellbeing strategy

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THE HEALTHY LIVERPOOL PROGRAMME

The Children’s and Young People’s Mental Health and Emotional Wellbeing Strategy is a key component of the Healthy Liverpool programme, which aims to transform health and care services in the city over the next five years.

The vision for Healthy Liverpool is for a health care system that is person-centred, supports people to stay well and provides the very best in care. For children and families, this means we will put them at the heart of what we do.

We want to create a future where everyone in the city receives consistent, high-quality healthcare, wherever they live; with care delivered in the home, in our communities, and in our hospitals and services for children and families to be designed in a joined up way with other key partners such as schools and Early Help services.

The case to transform health and social care in Liverpool is compelling. The city faces a number of challenges that if not addressed now have the potential to impact on the sustainability of local services and on health outcomes for Liverpool people. Action is required now to address these challenges, which include an ageing population, unacceptable inequalities in health, especially for a significant number of children and families, as well as wide variations in the quality of and access to services.

Health and social care services are to be transformed in order to realise the vision of a healthy Liverpool. This requires a new approach to care, by putting people first and having a better understanding all of a person’s needs. We call this person-centred care, which also means the child and their family will be at the centre of this new approach to care.

Managing the health and wellbeing of children is complex and challenging, requiring close working between multiple parties, including education, health and social services professionals.

Child health and wellbeing is closely related to poverty and to societal issues. Outcomes for children and young people in Liverpool are poor, with the health and wellbeing of children in the city generally worse than the England average and the level of child poverty, though improving, also worse than the England average.

Currently there are inconsistencies in the way care is planned, commissioned and delivered across the many partners involved. Children, young people and families tell us that they experience fragmentation, duplication, lack of clarity and uncertainty.


With growing demand and rising expectations, the current system is unsustainable and unfit for purpose. We need to develop a co-ordinated and integrated approach to children’s health and care services to achieve improved experiences and better outcomes. This approach will encompass a cohesive, holistic, family-based model so that, where necessary, we address an entire family’s needs rather than just an individual child’s needs.

Our objectives are to ensure there is Early Help, which means intervening as early as possible where a child has needs and to take a multi-agency co-ordinated approach to preventative and early intervention services.

Our priority is to ensure that children with complex neurodevelopmental needs and mental health problems are properly well cared for.

Addressing such needs at the earliest possible opportunity can prevent them worsening as the child grows older and can often prevent or reduce issues in adulthood.

Through Healthy Liverpool, children, young people and their families will be involved in the development of plans to transform the services they rely on.

INTRODUCTION – NATIONAL CONTEXTAt any one time in the United Kingdom, 10% of children aged 5 – 16 experiences a mental health problem, the majority of which are emotional disorders such as depression or anxiety (youngminds.org.uk).

In addition, many children (up to a further 10%) will have problems that affect their day-to-day living, their behaviour, achievement and happiness that are not at the level of diagnosable disorder but for which they need help.

Mental health problems impact on all aspects of life. The impact on the quality of life such as enjoyment, goal achievement and maintenance of physical and mental health can be high both long and short term. Mental ill health impacts directly on the thinking, emotions, decision-making and behaviour of the child as well as the mental and physical health of their family. 75% of lifetime mental disorders begin before the age of 18. There is strong evidence that mental health in childhood also affects the neuro-hormonal and autoimmune control mechanisms linking the brain to other body systems. In turn these impact on long-term physical health and can lead to premature death (Green et al, 2005).

Investing early with effective intervention in the first or second episodes in the 0-21 years age group will save money in the NHS, Local Authorities, courts, schools and other services as well as improving wellbeing.

Studies about the onset rates of illnesses of all types across the lifespan highlight that mental disorders represent the single largest category of burden of ill health onsets in children, adolescents and young adults, hugely outweighing the onsets of other health care related problems. Diagram 1 reflects this.

Overall, mental ill health is the single largest cause of disability in the UK. It contributes up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease (World Health Organisation, 2008).

The wider economic costs of mental illness in England have been estimated at £105.2 billion each year. This includes direct costs of services, lost productivity at work and reduced quality of life.

In 2008/9, the NHS spent 10.8% of its annual secondary healthcare budget on mental health services, £10.4 billion (Department of Health, 2010). When costs include social and informal care they amounted to £22.5 billion in 2007 in England (McCrone P, Dhanasiri S, Patel A et al, 2008).

Children and Young People make up 20% of the country’s population. They receive no more than 6% of NHS spending on mental health.

1 IN 10 CHILDREN AND YOUNG PEOPLE AGED 5 - 16 SUFFER FROM A DIAGNOSABLE MENTAL HEALTH DISORDER - THAT IS AROUND THREE CHILDREN IN EVERY CLASS (YOUNGMINDS WEBSITE, 2013)

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2 RATIONALE

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Child mental disorders produce costs across the health, education and social care system as well as in the community, police, criminal justice and welfare systems.

There is an impact on the quality of life for the individual as well as economic and cohesion costs to society. They occur concurrently later in adult life e.g. lost work and productivity, problems in family life and relationships.

In the last two years key policy changes have included: § The Health and Social Care Act (2012) putting mental health on a par with physical health with the duty of Parity of Esteem.

§ The changes in the Children and Families Bill 2014 rethink the way children with special educational needs (SEN) are supported, including new rights to personal budges. SEN statements and learning difficulty assessments (LDAs) are replaced with education, health and care (EHC) plans taking children and young people up to the age of 25. New assessments of SEN will follow the new rules, and support will be provided through an EHC plan. § Children and Young People will be entitled to a greater choice of provider within the Choice Initiative. § The expansion of the children’s IAPT (Improving Access to Psychological Therapies) programme (www.cypiapt.org).

This is a CAMHS transformation programme focusing on evidence based practice, workforce development, routine outcome measures, participation and self-referral. § Public Service Social Value Act requires public authorities to have regard to economic, social and environmental wellbeing in connection with public services contracts; and for connected purposes. § The Mental Health Strategy (2011). ‘no health without mental health’, which outlines 6 key objectives to improving the mental health and wellbeing of individuals across the life course.

This strategy will support the above policies and transformation programmes.

Age

CardiovascularCancerMental disordersNeurological & senseChronic respiratoryInjuriesMusculoskeletalOther

0 10 20 30 40 50 60 70 800

50

100

150

200

Incide

nce

YLD

rate p

er 1

,000

pop

ulat

ion

DIAGRAM 1: INCIDENT YLD RATES PER 1,000 POPULATION BY AGE AND BROAD DISEASE GROUPING VICTORIA 1996

Mental health problems are the greatest health problems faced by childen and young people


LOCAL CONTEXT:In Liverpool, children and young people’s mental health and emotional wellbeing is delivered and supported through a broad spectrum of agencies from both the statutory and voluntary sector. We believe that mental health is not about feeling happy all the time or solely focusing on treating mental illness, but having the resilience, social skills and ability to cope from an early age. It is about promoting the view that mental health should be as important as physical health. It is not the responsibility of one profession or organisation but about all agencies working together to meet the needs of the child, young person and family. It is about services being accessible to all children, young people and families regardless of their disability, culture, language, caring responsibilities, gender, sexual orientation, economic position, religion or vulnerability and ensuring that services are recognised for their contributions to the mental health and emotional wellbeing of children and young people. It is about taking a truly joint approach to commissioning and service delivery ensuring stakeholder engagement at all times. This includes children, young people and parents/carers. All of which is underpinned by a human rights approach specifically around the United Nations Conventions on the Rights of The Child (UNCRC). Liverpool’s Children and Young people’s MHEWB Partnership promotes and accepts the mental health definition provided by the World Health Organisation (WHO):

‘A state of wellbeing in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contributions to his or her community.’

For a number of years, children and young people’s mental health and emotional wellbeing has been explained using the term CAMHS (child and adolescent mental health services) using a 4 tiered model following the Health Advisory document ‘Together We Stand’ (1995).

It has been found that in many areas only services that operate at tiers 3 and 4 or at the specialist level are perceived as providing mental health support (CAMHS review, 2008). In Liverpool, we recognise the contributions that all services make towards this agenda, which has resulted in us using the broader term of mental health and emotional wellbeing or ‘Comprehensive CAMHS.’ and the joint commissioning and inclusion of a wide range of organisations from both the voluntary and statutory sector. We also recognise that some services will not fit into the tiered categories and will offer a range of support which will cross cut tiers.

The aim of this strategy is to take a collaborative approach to ensuring children and young people’s mental health and emotional wellbeing is ‘EVERYONE’S BUSINESS’ through building on the work and progress already made on mental health and emotional wellbeing in Liverpool.

We will do this by setting priorities and actions which are outlined within the action plan at the end of this document. These priorities and actions are to ensure we meet the mental health and emotional wellbeing outcomes agreed in Liverpool. This strategy will support and reflect our collaborative and inclusive way of working between commissioners, LCCG, LA, schools, providers, third sector and statutory and children, young people and their families. This allows us to implement our actions and priorities and to deliver a comprehensive CAMHS pathway which has been developed and commissioned in Liverpool, (see diagram 2).

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It will outline how we have improved our models of participation using human rights based approaches specifically around the UNCRC and how we empower CYP and families to be involved in the design, delivery and evaluation of mental health and emotional wellbeing services, at both the commissioner and provider level. The strategy will focus on our achievements and developments, which have resulted from strong evidence, research, and new and innovative ways of working. These will be highlighted throughout this report and within the action plan.

INFORMING STRATEGIC DIRECTION § Between 1 in every 12 and 1 in 15 children and young people deliberately self-harm. § There has been a big increase in the number of young people being admitted to hospital because of self-harm. Over the last ten years this figure has increased by 68%. (Youngminds website, 2013)

This strategy is informed by need, local and national policy and the contributions from a wide range of stakeholders including children, young people and families. The last two years has seen a re-design in mental health services for children and young people from a targeted, tiered model which focused on services working in specific areas (BME, LAC, 16-18, early years) to an integrated comprehensive pathway of care (see diagram 2) for all children and young people.

This re-design was in response to a number of consultations with stakeholders, who found the targeted, tiered model confusing, and at times, not accessible to all children and young people (see appendices). Although the re-design has been implemented following such concerns, the learning and innovative practice from many of the targeted services has remained and has been used to shape the new model, complimenting the strong partnership working between the statutory and voluntary sector CAMHS.


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DIAGRAM 2: COMPREHENSIVE CAMHS PATHWAYThe Comprehensive CAMHS Pathway (CCP) (see diagram 2), was developed using an outcomes based framework. It is needs led and involved children and young people, parents, carers and a range of stakeholders in its development. The aim of the pathway is to ensure mental health services and support is accessible to all children, young people and their families within Liverpool.

The CCP is made up of a range of providers from the voluntary and statutory sector. The Pathway takes an asset based approach, ensuring accessible information and support is available at all levels i.e. public health, early intervention, early identification, prevention and intervention.

It is a stepped model of care and children and young people can access the pathway at any stage dependant on their mental health needs.

The focus is to ensure that children and young people and their families are supported at the universal level within their communities.

Further information on the services provided as part of the pathway can be found using the following link: www.liverpoolfyi.com

Tier 4 Dewi Jones Unit (0-14)

Tier 4 YPC or CHEDS (14-18)

Tier 4 (Independent Sector)

Alder Hey Out of Hours Psychiatry 0-16 years

Mersey Care16 years plus

Other services (signposted)

Alder Hey CAMHS

Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Barnardos YC)

Triage (care aims framework)

Access to treatment

Referral to SPA or direct to any of the voluntary scetor CAMHS providers

See www.liverpoolfyi.com for service information

Training

CAMHS Offer:General mental health awareness raising to more specific / targeted training

Consultation and support

CAMHS Offer:Telephone, individual, group

Reduction in life long distress

Reduction in the development of Moderate to Severe Distress

Reduction in Mild to Moderate Distress

Increased identification of children and young people with early indicators of distress and risk

Improved environments so that children, young people and families can thrive

Children & young people and families

Universal Services

Accessible information and self-care

CAMHS Offer:Website www.liverpoolfyi.com

Mental Health Promotion workshops/support

Improved mental health of children & young people and families

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Mental health problems in Liverpool are expected to be high due to deprivation and the numerous risk factors associated with this area. These include: § The level of child poverty is worse than the England average with 33.6% of children under 16 years of age living in poverty. § There were 1000 children in care on 31 January 2014, which represents a higher rate when compared to the England average. § The number of 16-18 year olds not in education, employment or training (NEET) is significantly worse than the national average. § There are 346 Child Protection Plans in place (as at 31st March 2013) § There are 3756 children with care plans in place. § There are approximately 2105 ‘troubled’ families. § Barnardo’s young carers estimate that there are 3000 young carers in the city. § There are 502 children with disabilities open to the disabled children’s team § 17.1% of children and young people are from black and minority ethnic groups § 22.7% (101,000) of the population of Liverpool is aged 0-19 years old. The estimated mental health need at each tier based on this population size can be

viewed in the following table:

Tier Number

1 (universal) 12828 (15%)

2 (targeted) 5986 (7%)

3 (specialist- community) 1582 (1.85%)

4 (specialist – in patient) 64 (0.075%)

Locally there are approximately 5000 children and young people accessing Targeted (tier 2) and Specialist (tier 3) CAMHS per year. Approximately 20% of these are accessing Specialist (tier 3) CAMHS (1.04% of the population).

Additionally the numbers accessing tier 4 CAMHS, in patient care, for this last year is below estimated need at 0.007% which would suggest difficulties are being managed within local CAMHS provision (see diagram 3). There has been a reduction in children and young people accessing specialist CAMHS and in-patient units during the last 4 years. This is encouraging as it maintains children and young people within their homes, families and communities. This does not include looked after children placed out of the city or children with continuing health needs subject to joint funding packages who require CAMHS support.

2718

2286

1131 1040

0

500

1000

1500

2000

2500

3000

2010-2011 2011-2012 2012-2013 2013-2014

66

58

33

7

0

10

20

30

40

50

60

70

2011-2012 2012-2013 2013-2014 2014-2015


It is hoped by continuing to focus commissioning and delivery at an early intervention and preventative level, we can reduce these numbers further. The wider social determinants and increasing risk factors in Liverpool, as outlined previously, pose a great challenge to the early help and preventative model, which further emphasises the importance of partnership working and joint commissioning.

Many of those accessing CAMHS have experienced adverse childhood experiences (ACE) including parental separation, parent in prison, sexual and/or physical abuse, neglect and household substance misuse or mental illness. The ACE study (www.acestudy.org) outlines the correlation between childhood stressors and poor outcomes in mental health and wellbeing throughout the life courses. The Children and Young People’s Mental Health and Emotional Wellbeing Partnership supports this thinking and welcomes the opportunity to consider factors that are integral to individual, family and community experiences when strategically developing and commissioning services.

A Merseyside needs assessment for children and young people’s emotional health and wellbeing was carried out during 2012 by the Liverpool Public Health Observatory (Ubido, Holmes, McAteer, Tomlinson and Scott-Samuel, 2012), which outlined a number of recommendations, for CCG’s, Local Authorities and schools. The MHEWB Partnership welcomes these recommendations which have informed this 3 year strategy. The needs assessment outlines 6 priority areas, which were developed by the Children’s Society (2012) that contribute to positive and negative emotional health in children and young people;

§ The conditions to learn and develop § Good level of development at age 5 § A positive view of themselves and an identity that is respected § Have enough of what matters § Positive relationships with family and friends § A safe and suitable home environment and local area § Opportunity to take part in positive activities to thrive

These 6 priority areas have again informed this strategy and the integrated working which will continue to ensure there is consideration for the mental health impact of wider services and initiatives. A copy of this full report and a summary can be viewed by clicking on the link below:www.liv.ac.uk/PublicHealth/obs/publications/report/obs_report.htm

This strategy is informed by, and informs, the Joint Strategic Needs Assessment (JSNA) in addition to drawing upon national policies and guidance which are outlined in the foreword of this document. All of these documnets have common themes including the need for early intervention and prevention, thinking family, evidence based practice, developing the workforce, tackling stigma and involving children, young people and families. It will further support more local strategies and programmes including the Children and Young People’s Plan (2014), Health and Wellbeing Strategy (2012), the Anti-Homophobic Bullying Strategy (2010-2015), Supporting Families programme, Integrated Early Help Strategy (2014), Neglect Strategy (2014) and Liverpool CCGs’ Healthy Liverpool Programme which has identified children’s integrated care as one of its priorities. This will ensure a more integrated and joined up approach to commissioning and delivery of mental health and emotional wellbeing services for all children, young people and families.

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There is an evidence base in relation to the provision of mental health services and intervention for children and young people, as outlined in National Institute for Clinical Excellence (NICE) guidelines. While NICE guidelines rely largely on evidence based practice, robustly measuring outcomes of mental health and emotional wellbeing provision in Liverpool also allows us to develop creative services for children who do not neatly fall into clear categories (practice based evidence). This evidence base has been used to inform this strategy and the commissioning of services in Liverpool. We allow, and encourage, innovative practice ensuring outcomes and impact are robustly monitored and evidenced.

As with previous years, this 3 year strategy continues to be informed by research from the Foresight Study (2008). This study outlined the different approaches to mental health and wellbeing. This included ways in which the impact of programmes and interventions, might be identified and assessed through forms of capital (mental, social, human, identity, economic) and what individuals can contribute to society. This takes an asset based approach to mental health rather than needs based approach. It outlines the relationships between mental capital, biology, culture and environment and how our experiences depend upon personal and social interactions, particularly in early years. It incorporates the 5 evidence based actions to wellbeing:

1. Connect with people around you.2. Be active. Go for a walk and develop

a physical activity you enjoy.3. Take notice. Be curious. Catch sight

of the beautiful. 4. Keep learning. Try something new.5. Give. Do something nice for a friend,

or a stranger. Thank someone. Smile.

The report outlines the importance of intervening early in a child’s life, supporting parenting, improving environments and combining interventions in different settings. The benefits would include improved pro-social behaviour, improved attitudes to independent learning through life, and better resilience in terms of coping with the challenges of their future lives. This in turn would allow children to flourish, therefore achieving more positive outcomes. Further information regarding this report can be found by clicking on the link below:www.bis.gov.uk/foresight

Liverpool’s recently published Primary Mental Health Care Strategy for Adults (2014) focuses on four key elements of support to adults and families: § Practical: tackle poverty and social exclusion (debt management, welfare and housing advice and employment support). § Social: reduces loneliness and social isolation (psycho-educational groups, social prescribing, time banking, peer support and volunteering). § Psychological: psychological therapies (treatment of mild, moderate and severe mental health problems). § Physical: improve physical and mental health (mental health liaison to enable primary and secondary care to work together).

This takes a more holistic and systemic view to supporting adults with mental health difficulties and their families with a clear focus on early identification and intervention. The children and young people’s MHEWB strategy will support this way of thinking and work in partnership with adult services to take a whole family, collaborative approach and improve transition pathways.


UNDERPINNING PRINCIPLES Nearly 80,000 children and young people suffer from severe depression (Youngminds website 2013)

CARE AIMSThe Care Aims approach is a population based, person centred approach to health and wellbeing that requires each person responsible for the wellbeing of a child to provide evidence that they are doing their duty. It achieves this by providing a framework for clear reasoning and evidence based decision making which can be communicated clearly and effectively.

Liverpool MHEWB Partnership has developed a vision and mission for their CAMHS Providers based on the Care Aims philosophy.

We aim to deliver services that offer children, young people and their families and carers: § Information that will support them to manage their own health and wellbeing. § Access to different levels of service e.g. information, reassurance, advice, consultation, treatment and support. § Access to our services when they need it. § Providing the most effective, evidence based interventions we have available. § Clarity on our decisions. § Consistent and safe intervention.

We will do this by: § Engaging in health promotion/consultation activities with the public to reduce the need for referral and enhance self-help. § Making consistent and robust admission and discharge decisions, not thresholds, that reflect risk. § Including children, young people and families in the decisions we make, as far as possible. § Taking an outcomes based approach to working with individuals. § Systematically agreeing and reviewing the outcomes of our interventions with the people we serve.

§ Communicate our decisions effectively through clear explanations to families and colleagues in all agencies, through good case notes and through quality reporting. § Seeing people only for as long as they need our help and handing back responsibility as soon as it is safe to do so thus avoiding dependency. § Signposting to other appropriate services/agencies. § Working in partnership with colleagues in the multi-disciplinary/multi-agency team to ensure the best possible understanding and management of risk in the population and individual families. § Supporting our staff to be confident that their decisions are as evidenced based as possible. § Having accurate and timely data that reflects quality. § Taking time to reflect on our practice with our peers.

One of the key principles of Care Aims is “Prevention is Better than Cure” and helping the population to manage its own risks is the most effective way of improving the city’s health and wellbeing.

WHOLE FAMILYAs highlighted in the previous Strategy the mental health and emotional wellbeing of Liverpool children and young people needs to be viewed in the wider framework of the ‘think child, think parent, think family, think community’ model. This work has historic roots in Liverpool given we were one of five sites nationally selected on the basis of promising practice, to implement the Social Care Institute for Excellence (SCIE) Guide which supports families impacted by parental mental ill health. This allowed us to raise awareness and give urgency to the agenda, with the aim being to deliver high quality services for families by taking a multi-agency approach and working across both child and adult services to achieve better outcomes for families.

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From 2010-14, we have continued to learn and develop the think family approach and what is now more commonly described as a whole family approach, to support the families, taking into account the individual needs and the combined needs of the child, parent and family. The strong evidence base firmly supports what is quite simply a sensible and extremely effective approach. Further information of the Liverpool achievements an can be found locally at: § www.merseycare.nhs.uk/thinkfamily § www.liverpool.gov.uk/council/strategies-plans-and-policies/children-and-families/think-family/

It can also be found nationally as part of the SCIE Evaluation and Implementation at: § www.scie.org.uk/children/parentalmentalhealthandchildwelfare/

Throughout this period, there has been the need to ensure connectivity across planned and current activity, whereby families’ strengths are built on and support tailored to needs. This has been critical during this timeframe because the Liverpool Families programme came on stream in April 2013, and the work has been able to further develop as a result of the learning to date. This strategic work programme across LCC and partner agencies, seeks to embed a family-focus in the design, delivery and development of services to families in Liverpool in order to improve outcomes and reduce costs. The ambition is for families in Liverpool to have resourcefulness and resilience along with the attitude, skills and behaviours that will enable them and the city to thrive.

We need to ensure that the focus is on services working smarter together alongside families - doing with and not to or for families. The focus is also on increasing resilience and reducing duplication, costs and long term dependence on services.

The overall aim is to secure improved intelligence about families at risk, provide earlier support where issues are identified, encourage better information sharing across organisations, and have fewer professionals involved with families. For those who are they will be encouraged to work within the context of the whole family and deliver a culture change within and across organisations based on working with families, embedding a ‘whole-family’ approach. This clearly supports the MHEWB agenda and is mutually compatible.

The purpose of the Troubled Families programme is twofold: To provide the framework for multi-agency engagement with our current cohort of families identified through the Troubled Families Programme; and to shape the future design, development and commissioning of services to make best use of available resources and improve outcomes for families.

The MHEWB strategy fits and aligns on all levels with the programme. It is built on the principles of prevention – looking to identify issues at the earliest opportunity and work collectively with families to reduce the risk of these issues getting worse; intervention – sharing our knowledge and targeting support towards those families who need more; progression – ensuring interventions have a positive impact and offer families the opportunity to sustain improvements themselves.

RESILIENCE Promoting resilience is a key factor within this strategy, as this can strengthen a child or young person. Children may have their own resilience factors, such as their personality or their own inner resources. However, children and young people may need additional support to develop more wide-ranging resilience factors such as, developing communication skills, emotional literacy, problem solving techniques and helping them to self reflect.


Children and young people need such resources to be able to navigate through life and to deal with risk factors which could cause harm, rendering children vulnerable. Children and young people may also require support to enable them to deal with their lived reality. This support should be provided through the promotion of resilience: promoted within the family, the community and at the structural level (services such as education, health, criminal justice agencies, and social services). This is an important aspect of our work, as children face numerous risk factors throughout their lives. This strategy aims to do this by taking a human rights approach to delivery and promoting the welfare of children and young people.

UNCRCNot only is Liverpool’s children and young peoples mental health and emotional wellbeing agenda driven by local and national policy, it is underpinned by a human rights approach. More specific to this strategy is the ‘United Nations Convention on the Rights of the Child’ (UNCRC) which should be central to all practice with children and young people. This document consists of 42 articles in relation to children and young people and can be explored under three themes: Protection, Promotion, and Participation. Essentially, all services should truly consider ways in which they can promote the principles of the UNCRC to the children and young people they work with and ensure the articles are embedded within their culture. In Liverpool we ensure all our mental health services adhere to the UNCRC and we inform children, young people and their families about them. This includes monitoring their use, as a requirement within service contracts, through the performance monitoring framework and participation agenda.

SAFEGUARDINGSafeguarding is integral to this agenda and we actively promote the responsibilities of all agencies to promote the welfare of children and young people. Agencies that work with children and young people have a wider role than simply protecting them from neglect and abuse. This role involves keeping them safe from accidents, crime and bullying and actively promoting their welfare in a healthy and safe environment. Although all contracts for mental health services are closely monitored in accordance with clearly defined safeguarding requirements, we recognise that more work needs to develop within this area. This need is specifically in relation to transitional arrangements for young people and the use of the Early Help Assessment Tool (EHAT). Liverpool Safeguarding Board is integral to this work and has mental health and emotional wellbeing as a priority within their work streams. Further information can be found at www.liverpoolscb.org.uk

EQUALITIES The MHEWB is committed to achieving equality in both commissioning and service delivery. There is therefore a strong equalities agenda throughout the comprehensive CAMHS pathway. This ensures equitable and accessible provision to meet the needs of all communities. The MHEWB Partnership Board are committed to ensuring: § Making Equalities everyone’s business. § Raising the knowledge of the protected characteristics within the Equalities Act 2010. § Developing the role of Equalities Champions within all CAMHS providers. § Ensuring all staff within CAMHS receive appropriate training and develop skills to support all children and young people and making their services more accessible.

17

SOCIAL VALUE:The Public Service Social Value Act (2012) requires public authorities to have regard to economic, social and environmental wellbeing in connection with public services contracts, and for connected purposes. This strategy will aim to support LCCG’s Social Value strategy (2014) and support their commitment to the Sustainable Development Strategy for the Health, Public Health and Social Care System 2014-2020.

This describes the vision for a sustainable health and care system, and the challenge to continually improve health and wellbeing and deliver high quality care now and for future generations within available financial, social and environmental resources. This strategy will aim to improve the mental health and emotional wellbeing of children, young people and families by embedding social value into commissioning, workforce development, resources and models of care.

All of this will be overseen through the Governance structures in place as part of the MHEWB Board and collaborative working with children, young people, families and partner agencies from the statutory and voluntary and community sector.


19

72% OF CHILDREN IN CARE HAVE BEHAVIORAL OR EMOTIONAL PROBLEMS - THESE ARE SOME OF THE MOST VULNERABLE PEOPLE IN OUR SOCIETY(YOUNGMINDS WEBSITE, 2013)

Clinical Governance and risk management within organizations is essential. All mental health services have clear clinical and supervisory arrangements, mandatory training, continuing professional development, regular professional development reviews with structures and processes to ensure DBS checks, professional registration and qualifications are kept up to date.

The lines of accountability locally for Children and Young People’s Mental Health and Emotional Wellbeing can be viewed in the following diagram.

The multi-agency Children and Young People’s Mental Health and Emotional Wellbeing (MHEWB) Partnership Board leads on the strategic direction of this agenda in Liverpool. This group is accountable to the Health and Wellbeing Board through the Children’s Trust Board. It is also a key priority within

the Healthy Liverpool Children’s Integrated Care Programme and reporting structures will be developed during the next 12 months.

Liverpool has jointly commissioned children and young people’s mental health and emotional wellbeing services since 2003. This involves a collaborative and partnership approach between; Liverpool CCG, schools, Liverpool City Council and social care. It is envisaged that this joint commissioning will continue for the foreseeable future given Mental Health and Emotional Wellbeing is ‘EVERYONE’S BUSINESS.’

Operating parallel to the MHEWB Partnership Board is ‘FYI’ (Fun Youth Involvement) and existing parent/carer groups. These include groups of children and young people and parents/carers who have experience of accessing mental health services in Liverpool.

These groups are involved in service development, design and evaluation through representation on the MHEWB Partnership Board.

The performance monitoring framework for the comprehensive CAMHS pathway is made of four components: § Finance: Monitored through Liverpool CCG. § Activity: Monitored via quarterly returns. § Outcomes and Impact: Reported through quarterly returns and the annual CORC (CAMHS Outcomes Research Consortium) process. (A national organization identified as good practice for the collection of outcomes in children and young peoples mental health services) § Quality: Monitored via annual visits, quarterly returns and CORC which measures experience of service, service satisfaction and complaints

The information provided through the above framework allows us to ensure services are effective, efficient, accessible and developed based on need. In addition to supporting the performance monitoring of the action plan, (at the end of this strategy)this information helps to inform future commissioning decisions and supports commissioners in understanding the terrain in which providers operate.

Health and Wellbeing Board

Children’s Trust Board

MHEWB Partnership Board

Priority Working Groups

FYI (CAMHS children and young people advisory forum) plus existing parent/carer groups

3 ENSURING QUALITY AND GOVERNANCE


21

OVER 8,000 CHILDREN AGED LESS THAN 10 YEARS OLD SUFFER FROM SEVERE DEPRESSION.(YOUNGMINDS WEBSITE, 2013)

The Children and Young People’s MHEWB agenda in Liverpool has had strong stakeholder engagement since developments began in 2003. This strategy has therefore been developed through the involvement of all stakeholders specifically children, young people and families. Further to this is the development of the participation agenda in Liverpool and commitment at both the commissioner and provider level to involve children, young people and families in mental health and emotional wellbeing service design, delivery and evaluation.

The MHEWB partnership board identifies the many different models of participation that individual providers use in engaging with CYP and parents/carers and the good work that already exists. It recognises that not all children, young people and parents/carers want to participate but promotes the importance of providing the mechanisms and opportunities to do so if they wish. The Partnership Board has supported the development of FYI which is the framework in which children and young people are involved at the commissioning and provider level.

In addition, parent/carers are involved in the participation agenda through a variety of different mechanism e.g. agenda days, their own networks and attendance at partnership board meetings. Involving children, young people and parents/carers has helped to inform commissioning decisions and develop services. This work has been recognised through the receipt of a national award.

Wider stakeholder engagement is carried out using a variety of methods. These include: § Attendance at school consortia § Attendance at locality meetings § Children’s Trust Board structures § CCG locality leads § CCG GP lead for CAMHS § Attendance at social care meetings, if required § 0 – 25 network at LCVS (Liverpool Council for Voluntary Services)

4 STAKEHOLDER ENGAGEMENT

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MORE THAN HALF OF ALL ADULTS WITH MENTAL HEALTH PROBLEMS WERE DIAGNOSED IN CHILDHOOD. LESS THAN HALF WERE TREATED APPROPRIATELY AT THE TIME.(YOUNGMINDS WEBSITE, 2013)

The aim of this strategy is to take a collaborative approach to ensure children and young people’s mental health and emotional wellbeing is ‘EVERYONE’S BUSINESS’ by building on the work and progress already made within Liverpool.

The action plan in the next section outlines our key developments for the next three years based on priority areas. These developments have been informed through wide stakeholder engagement and need. These developments will support the outcomes agreed in Liverpool, which are outlined in the foreword, at the beginning of this document. This is a working document and will be regularly monitored and updated over the next three years. These key developments are: § Mental health promotion, tackling stigma and self care § Intervening early in children and young peoples lives to prevent mental distress, and raising the visibility of mental health and emotional wellbeing § Transition of young people to adult provision

§ Equalities through CAMHS and improving access § Integrated working § Participation and stakeholder engagement § Whole family approaches § Workforce development § Complex mental health needs § Outcome monitoring § Joint commissioning

It is important to recognise the achievements made over the last three years and these are outlined within the appendices.

It is important that we continue to work together in partnership with all stakeholders, children, young people and their families across the life course to continually support the mental health and emotional wellbeing of the local population.


5 AIMS AND OBJECTIVES5 AIMS AND OBJECTIVES

KEY DEVELOPMENTS PRIORITIES FOR 2014-2017 RAG RATING (PERFORMANCE AND IMPACT)

MENTAL HEALTH PROMOTION, TACKLING STIGMA AND SELF CARE

Developments over the past three years have focused on awareness raising through training, mental health promotion, awards for schools and partnership, attendance at a number of events and campaigns to promote the message of mental health being ‘EVERYONE’S BUSINESS’.

§ Ensure children and young people and their families have access to information about mental health and emotional wellbeing by further developing www.liverpoolfyi.com and in line with the local offer of provision as part of the Children and Families Act (2014).

§ Wider promotion of mental health and emotional wellbeing through tackling stigma campaigns, workshops, national and local events (World Mental Health Day) award for schools. This will include working with the national tackling stigma campaign ‘Time to Change.’

§ Deliver general mental health awareness training.

§ Development of a range of mental health promotion resources to emphasise the importance of looking after your mental health, partnership approach to delivery and tackling stigma.

§ Use of a range of media to promote mental health and emotional wellbeing.

§ Continual use and development of ‘Mind Apples’ – 5 a day for your mental health and emotional wellbeing.

§ Ensure all mental health promotion resources are accessible to all communities specifically those within the protected characteristics of the Equalities Act 2010.

INTERVENING EARLY IN CHILDREN AND YOUNG PEOPLE’S LIVES TO PREVENT MENTAL DISTRESS AND RAISING THE VISIBILITY OF CAMHS

Developments during the last 3 years have focused on a range of early intervention and preventative approaches including training, support and consultations to a number of organisations within both the children’s and adult workforce. These have been delivered through a range of CAMHS provided through the voluntary and statutory sector.

§ Have a range of mental health training targeted at the children’s and adult’s workforce as well as children, young people and parents/carers delivered by the CAMHS partnership. This will include training on the referral process and use of the Early Help Assessment Tool.

§ Access for the children’s and adult workforce to consultation around mental health and emotional wellbeing from a range of CAMHS practitioners. This will include dedicated time to the Family Nurse Partnership and adult mental health support workers.

§ All schools, children’s centres and primary care will have access to a named CAMHS practitioner for joint thinking/joint working and any interventions required.

§ CAMHS representation at the appropriate education panels, e.g. Fair Access panels, Early Years Early Intervention panel.

§ Primary Mental Health service and multi-agency offer will operate in an integrated locality model and work in partnership with Adult Primary Mental Health Liaison.

§ A range of parenting interventions including Webster Stratton Incredible Years, Nurture groups and Solihull delivered by the CAMHS Partnership which is informed through need by working with Liverpool’s parenting and whole family programme

§ For the CAMHS partnership to work collaboratively with the Parenting Infant Partnership (PIP) and development of the peri-natal mental health pathway.

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6 ACTION PLAN 2014-2017


TRANSITION OF YOUNG PEOPLE TO ADULT PROVISION

A number of developments have taken place during the past three years to support young people facing the transition from child to adult mental health services. This has included the development of new teams and services in addition to better partnership working in order to develop a smoother transition which best meets the needs of young people and their families.

§ Continue further development of the transition CQUIN (Commissioning for Quality and Innovation) between Alder Hey CAMHS and Mersey Care. This will include the wider CAMHS and Adult Mental Health partners, who support young people aged 14-25 years as we work towards a ‘Youth Mental Health Model.’ Developments include:

- Audit of referrals and sample of cases

- Training and awareness raising re: transition and youth mental health

- Shared transition protocol across CAMHS and AMHS which is disseminated and implemented

- Youth participation

- Development of youth mental health and learning disabilities network

- Development of a youth mental health model

§ To further strengthen and develop tier 3 to 4 pathways for children and young people in partnership with NHS England.

§ To work within the remit of the Healthy Liverpool programme regarding transition ensuring:

- Person centred health plans to be initiated for the process of transition from age 14 for all children identified by the team around the child moving between childhood and adulthood within all clinical services including mental health services .

- Baseline established to set up database of young people from age 14 onwards, across all clinical specialties.

- Training of staff in person centred transition health planning

- Evidence of liaison and advice to the young person’s GP with agreed transition health plan in place.

- Evidence of multi-disciplinary working in the production of the transition plan; with a lead professional identified for each young person to liaise and coordinate the transition process (including handover).

- Involvement of the young person evidenced as an essential element of the plan.

- To improve young people’s experience of transition and reduce risks over this period.

- To develop transition protocols to improve quality and experience of transition.

- For there to be at least one transition planning meeting involving the service user and/or family and key service representatives, prior to handover.

- A period of parallel care involving joint working between relevant children’s / adult services.



EQUALITIES THROUGH CAMHS AND IMPROVING ACCESS

During the last three years the CAMHS Partnership Board and commissioning group have continued to ensure all our CAMHS are accessible to all children, young people and their families, specifically those from vulnerable groups.

§ To ensure all CAMHS practitioners have the skills and competencies to meet the needs of all communities by accessing relevant training. This will include training on different elements of the equalities agenda e.g. gender variance, cultural competency and age.

§ To continue partnership working between CAMHS providers and the Community Development Worker to ensure the needs of BME groups are identified and met. This will include a range of developments and community based interventions which improve the awareness and access into CAMHS and reduce stigma around mental health within these communities.

§ Continue to provide a range of targeted support for those children, young people and families as identified within the protected characteristics of the Equalities Act (2010) including specialisms across the CAMHS partnership.

§ To triage vulnerable groups as a priority within the SPA.

§ To provide dedicated consultation time to practitioners working with vulnerable groups.

§ To refresh and develop Equalities through the CAMHS group to ensure all CAMHS practitioners have a forum to share best practice, strengthen relationships and partnership working with targeted services (e.g. Irish Community Care Merseyside, Barnardos Young Carers, Arabic Centre, GYRO), develop training and data collection.

§ Further development of a multi-agency CAMHS Single Point of Access (SPA) to ensure referrals are directed to the appropriate service in a timely manner using the Care Aims framework.

§ To offer self- referrals across the full range of CAMHS providers.

§ To develop the transgender pathway.

INTEGRATED WORKING

A number of CAMHS now work within children’s centres, schools and community groups in order to improve access and meet the needs of children, young people and families.

§ To continue to collect demographic information to inform needs within each neighbourhood and locality. This will include information collected through the Joint Strategic Needs Assessment.

§ To explore opportunities to co-locate staff and resources in a locality based model as led through the Healthy Liverpool Programme and Early Help Offer.

§ To explore opportunities to share information systems across providers, as led by the Healthy Liverpool programme and Early Help offer.

§ For all schools to have access to a named CAMHS practitioner.

§ For all children centres to have access to a named CAMHS practitioner.

§ For all GP practices to have access to a named CAMHS practitioner for primary care liaison.

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PARTICIPATION AND STAKEHOLDER ENGAGEMENT

The involvement of all stakeholders in the design, development and evaluation of CAMHS in Liverpool is extremely important. Key to this is children, young people and families.

§ To engage and involve children, young people and families in the design, development, delivery and evaluation of mental health services in Liverpool.

§ To continually review, refresh and develop the CAMHS participation forum, FYI (Fun Youth Involvement) in partnership with children, young people and stakeholders.

§ To raise awareness of the importance and outcomes of participation as part of the UNCRC.

§ To work within CYP IAPT principles for children, young people and parents/carers ensuring it meets local need.

§ To strengthen and develop partnership working with parents/carers through different parent/carer support networks.

§ For each CAMHS provider to have a participation lead/champion who will ensure that children, young people and families involvement is embedded in practice.

§ To continue meeting as a Mental Health and Emotional Wellbeing Partnership Board quarterly to ensure wide stakeholder engagement and further development.

§ To continue with the multi-agency participation in CAMHS working group co-ordinated through the participation worker to steer this agenda.

§ To continue performance monitoring and audit participation against the requirements set out in service specifications and contracts. This will include reviewing the outcomes and impact of participation.

WHOLE FAMILY

CAMHS are part of the ‘Whole Family’ agenda in Liverpool and have been part of many developments in this area. All our providers are required to work within the ‘Whole Family’ model and framework understanding the importance of working systemically

§ Continue to ensure CAMHS providers meet the requirements outlined within contracts to work within the whole family agenda. This includes multi-agency working across whole systems to meet the needs of children, young people and their families and monitoring this through the performance monitoring process.

§ To ensure there is CAMHS representation as part of the ‘Whole Families’ agenda and at any strategic boards associated with this.

§ To deliver a range of family based interventions across the CAMHS providers.

§ To develop a support network for parents/carers of children and young people who are experiencing mental health difficulties.

§ To work closely with adult services at both the commissioner and provider level to look at developing services and the workforce in relation to the ‘Whole Family’ agenda.


27


WORKFORCE DEVELOPMENT

We want to ensure our CAMHS workforce is robust and fit for purpose. During the past three years the CAMHS workforce has increased. Most of our CAMHS commissioned services provide training within their specialist area in order to raise awareness and improve the skills of those working at a lower threshold. Those professionals working within CAMHS are also accessing further training to improve their skills.

§ To use the analysis of the Training Needs Survey to inform and develop a menu of free training for the children’s and adult workforce.

§ To have a co-ordinated approach to the menu of training offered and for this to be delivered as a partnership across all CAMHS providers. This will be promoted widely across the children’s and adult workforce

§ To ensure the CAMHS training offer feeds into Liverpool’s workforce development strategy.

§ To ensure all commissioned services have a workforce that is fit for purpose and meets the requirements outlined in contracts e.g. safeguarding training, disclosure and barring checks, professional membership, appropriate qualifications and commitment to continual professional development.

§ All CAMHS providers will have robust Governance structures in place (information, clinical and structural).

§ Service transformation will be a key element for all CAMHS providers using the supported offered through the children and young peoples IAPT (Improved Access to Psychological Therapies) programme, specifically in relation to self referrals and session by session outcome measures.

NEURODEVELOPMENT DIFFICULTIES AND COMPLEX NEEDS

Systems and services have been developed during the last 3 years to ensure those children and young people with more complex needs and their families receive appropriate mental health care and support

§ To review the current ASD (Autistic Spectrum Disorder) pathway with the longer term aim of developing a neurodevelopment pathway.

§ To look at opportunities in developing a multi agency tier 3+ service locally .

§ To look at opportunities to develop CAMHS out of hours provision (0-18 years) supported through the transition CQUIN, 7 day working and Healthy Liverpool programme.

§ Continual use of Care Programme Approach and range of interventions to meet need and complexities within specialist CAMHS.

OUTCOME MONITORING

During the past three years CAMHS providers have improved their systems to collect better and more meaningful outcomes as well as outputs

§ Implement session by session outcome monitoring across the CAMHS providers.

§ For all CAMHS providers to feed into the relevant national datasets including CORC (CAMHS Outcomes Research Consortium).

§ Further develop local reporting mechanisms to ensure they meet all commissioners’ needs, and evidence meeting the outcomes agreed for this strategy.

§ Commissioners and providers continue to work together to improve IT systems to collect data requested as led through the Healthy Liverpool programme.

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JOINT COMMISSIONING

Since 2003 LPCT and LCC have worked in partnership to jointly commission CAMHS in Liverpool in order to ensure a comprehensive CAMHS for all children and young people and their families is developed

During the last 3 years the commissioning process has become more transparent and structured.

§ To continue working in a joint commissioning framework for CAMHS in Liverpool.

§ Continued partnership working between commissioners and providers to develop services informed through need and evidence based practice.

§ Continue to support providers to use innovative ad creative approaches to develop practice based evidence.


§ Adverse Childhood Experience study (ACE), www.acestudy.org

§ Anti-Bullying Forum, Liverpool, 2010 Liverpool Children, Families and Adults Service Anti-Homophobic Bullying Strategy, www.liverpool.gov.uk

§ CAMHS Outcomes Research Consortium (CORC), www.corc.uk.net

§ Child Poverty and Life Chances Strategy, 2011 -2014, www.liverpoolcitystrategyces.org.uk

§ Children and Young People Plan for Liverpool, 2013, www.liverpool.gov.uk

§ Children and Young Peoples Health outcomes Forum, 2013, www.gov.uk/government/publications/independent-experts-set-out-recommendations-to-improve-children-and-young-people-s-health-results

§ CYP IAPT, www.cypiapt.org

§ Department for Children, Schools and Families, 2009 Think Family programme, www.dcsf.gov.uk

§ Department for Education, 2013, The Children and Families Bill, www.education.gov.uk/a00221161/children-families-bill

§ Department of Health and Department for Children, Schools and Families, 2008, Children and Young People in Mind: The Final report of the National CAMHS Review: London, http://webarchive.nationalarchives.gov.uk/*/http://www.dcsf.gov.uk/

§ Department of Health (2010) Programme budgeting tools and data www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Programmebudgeting/DH_075743

§ Department of Health, 2014, ‘Closing the gap: priorities for essential change in mental health,’ www.dh.gov.uk

§ Department of Health, 2012, Health and Social Care Act, www.dh.gov.uk

§ Department of Health, 2011, Mental Health Strategy ‘No Health without Mental Health,’ www.dh.gov.uk

§ Department for Health, 2013, Public Health Outcomes Framework for England, www.dh.gov.uk

§ Green H, McGinnity A, Meltzer h et al. (2005) Mental Health of Children and Young People in Great Britain, 2004. Basingstoke: Palgrave Macmillan.

§ Health Advisory Service. 1995. Together We Stand: The commissioning, role and management of child and adolescent mental health services. London: HMSO.

§ Health and Wellbeing Strategy for Liverpool, 2012-2015, www.liverpoolccg.nhs.uk or www.liverpool.gov.uk

§ Liverpool Clinical Commissioning Group www.liverpoolccg.nhs.uk

§ Liverpool FYI, www.liverpoolfyi.com

§ Liverpool’s Integrated Early Help Strategy, 2014, http://liverpool.gov.uk/council/strategies-plans-and-policies/children-and-families/early-help-strategy/

§ Liverpool’s Joint Strategic Needs Assessment, 2013, www.liverpool.gov.uk

§ Liverpool’s Multi - Agency Neglect Strategy 2014-2016, http://liverpool.gov.uk/council/strategies-plans-and-policies/children-and-families/multi-agency-neglect-strategy-2014-2016/

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REFERENCES

30

§ Liverpool’s Primary Mental Health Care Strategy for Adults, 2013-2016, http://www.liverpoolccg.nhs.uk/Health_Services/mental_health.aspx.

§ Liverpool Public Health Observatory, 2012, Children and Young People’s Emotional Health and Wellbeing Needs Assessment for Merseyside, www.liv.ac.uk/PublicHealth/obs/publications/report/obs_report.htm

§ Liverpool Safeguarding Board, www.liverpoolscb.org.uk

§ McCrone P, Dhanasiri S, Patel A et al (2008). Paying the price: the cost of mental health care in England to 2026. London: King’s Fund.

§ National Institute of Clinical excellence, www.nice.org.uk

§ New Economics Foundation, Foresight Project on Mental Capital and Wellbeing, www.neweconomics.org/projects/five-ways-wellbeing

§ Public Service Social Value Act, 2010, www.legislation.gov.uk/ukpga/2012/3/enacted

§ Supporting Families, www.liverpool.gov.uk

§ Social Care Institute for Excellence, www.scie.org.uk

§ United Nations Convention on the Rights of the Child, www.unicef.org.uk

§ World Health Organisation, www.who.int

§ World Health Organisation (2008) Global burden of disease report www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html

§ Youngminds, www.youngminds.org.uk


Achievements 2010-2013 Organisation Key Development

Development of CAMHS Website: www.liverpoolfyi.org

MYA lead organization in partnership with FYI

INTERVENING EARLY IN CHILDREN AND YOUNG PEOPLES LIVES TO PREVENT MENTAL DISTRESS AND RAISING THE VISIBILITY OF CAMHS

Developments during the last 3 years have focused on a range of early intervention and preventative approaches including training, support and consultations to a number of organizations within both the children’s and adult workforce. These have been delivered through a range of CAMHS provided through the voluntary and statutory sector.

The column to the left outlines some of what has been achieved during the last three years.

Delivery of range of training to the children’s and adults workforce by the CAMHS providers

All CAMHS Providers

Electronic booking system for training MYA

Development and analysis of training needs survey for children’s workforce

MYA and Alder Hey CAMHS

Development of films to support the promotion of Liverpool’s comprehensive CAMHS pathway

All CAMHS Providers

Development and delivery of mental health promotion award, PEERS (Positive Experiences Excellent Results)

MYA

Successfully delivered the DfE TAMHS (Targeted Mental Health in schools) programme within the BESD schools and pupil referral units

MYA

Successfully delivered the DH Tackling Stigma pilot within Liverpool

MYA in partnership with FYI

Development of multi-agency Single Point of Access

Alder Hey lead organization in partnership with YPAS, PSS, Barnardos and ADHDF

Development of Primary Mental Health Service offering training, consultation, joint thinking/working and brief intervention

Alder Hey CAMHS

Bonding with Baby programme delivered published within Clinical Psychology Forum (2011)

Alder Hey CAMHS

Updating of promotional material YPAS

Facilitated needs led community based groups for young people who hear voices

YPAS

Embedded the care aims framework into practice

All CAMHS Providers

Successful in DfE BOND (Better Outcomes New Delivery) pilot

All VCS CAMHS Providers

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APPENDIX


Liverpool identified as one of the 10 national pilots for GP champs led through YPAS and Brownlow Hill Practice

YPAS

Dedicated supervision provided to adult mental health family support workers and family nurse partnership

Alder Hey CAMHS

Named practitioner for schools and children’s centres within Primary Mental Health team

Alder Hey CAMHS

upport to the development of the peri-natal mental health pathway

Alder Hey CAMHS

Implementation of transition CQUIN across Alder Hey CAMHS and Merseycare including recruitment of Transition worker and team and joint transition protocol

Alder Hey CAMHS and Merseycare

TRANSITION OF YOUNG PEOPLE TO ADULT PROVISION

A number of developments have taken place during the past three years to support young people facing the transition from child to adult mental health services. This has included better partnership working in order to develop a smoother transition which best meets the needs of young people and their families.


Established joint working relationships with adult mental health to support future developments and a more holistic approach to addressing the transitional needs of young people

YPAS

Involvement in Adult Mental Health developments

YPAS

Regular Transfer of Care (TOC) meetings held between Alder hey CAMHS and Merseycare to ensure complex transitions are managed appropriately


16-18 service handbook written for Alder Hey CAMHS to clarify service provision for this age group and to ensure that young people needs are met by the most appropriate service in the city

Alder Hey CAMHS

Dedicated consultations and support offered to services working with 16-18 year olds

Alder Hey CAMHS



Parent Infant mental health project run with asylum seeking mothers and babies. Programme outcomes published in the Journal of Public Mental Health in 2012.

Alder Hey CAMHS and Community Development Worker

VULNERABLE GROUPS

During the last three years the CAMHS Partnership Board and commissioning group have continued to ensure all our CAMHS are accessible to all children and young people and their families, specifically those from vulnerable groups.


Self soothing programme designed specifically for LAC under 10 years of age to promote emotional wellbeing and mitigate against placement disruption. Further to developed to address needs of other populations

Alder Hey CAMHS

Equalities through CAMHS conference held for all CAMHS providers

All CAMHS Providers

Equalities through CAMHS working group established

All CAMHS providers

Equality Impact Assessments completed and recommendations implemented

YPAS

Delivered LGBTQ Service for young people including membership on Northwest steering group and development of anti-homophobic bullying strategy

YPAS GYRO

Delivered information, advice and guidance support to vulnerable c&yp who have experienced homelessness and poverty

YPAS

Delivered therapeutic surgeries in Sandfield Park school with children and young people with disabilities

YPAS

Liverpool Pride – Led a comprehensive partnership to provide dedicated alcohol- free youth space to 13-17 year olds

YPAS

Provided therapy to young people who are deaf and had English as a second language with the support of interpreters.

YPAS

Development of a community based programme with Somali, Yemeni and black born fathers and sons

Community Development Worker and Alder Hey CAMHS

Early years mental health programme for BME communities within Toxteth and Speke

Community Development Worker and Alder Hey CAMHS

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34


Consultations in partnership with Liverpool University to Iraqi parents around their physical and mental health needs

Community Development Worker

Mental health awareness workshops delivered within Liverpool Arabic centre and as part of the Arabic Arts festival


Development of forced marriage and Honor based violence protocol


Development of lead practitioners with Specialisms in Alder Hey CAMHS e.g. LAC, YOS, LD, BME

Alder Hey CAMHS

9 week behaviour management course for parents/carers of children and young people with LD and behaviour difficulties

Alder Hey CAMHS

Sleep service for children aged 0-5 years with LD developed and delivered in partnership with Childrens Centres

Alder Hey CAMHS

Dedicated consultations to practitioners working within YOS, LAC, LD and safeguarding teams

Alder Hey CAMHS

Dedicated consultations and support to special schools using the Team Around the School model

Alder Hey CAMHS

Residential Support programme to the 3 Local Authority Childrens homes

Alder Hey CAMHS

Foster Care training Alder Hey CAMHS

Therapeutic service specializing in trauma and recovery for refugee and asylum seeking children and young people who have experienced human trafficking, exposure to situations of warfare, torture and ill treatment. Working across many different languages, cultures with an average attendance rate of 80%.

PSS Spinning World

Piloting family group meetings for young carers


Joint thinking and working with Merseycare family support workers, CAF support team and Early intervention Team




Review of Gender Dysphoria pathway and services for children and young people Alder Hey CAMHS and Community Development Worker

All CAMHS providers and commissioners

Development of an integrated comprehensive CAMHS pathway

Commissioners, all providers, stakeholders, children, young people and families

INTEGRATED WORKING

A number of CAMHS now work within children’s centres, schools and community groups in order to improve access and meet the needs of children, young people and families.


Further developed partnerships and strategic relationships with cross sector organizations from health, education, social care and youth justice

All CAMHS providers

Innovative arts project with Curious Minds to ensure the promotion of wellbeing through the creative use of arts

YPAS

Range of interventions delivered within localities and communities

All CAMHS Providers

Named lead/champions for different areas, e.g. Equalities, schools, primary care, Children’s Centres, LAC, YOS

Alder Hey CAMHS

Supporting schools consortia meetings and Locality Teams

Alder Hey CAMHS

Weekly consultation to Fair Access Panel and Primary Fair Access Panel (schools)

Alder Hey CAMHS

Regular consultations to Secondary and Primary Education Centres

Alder Hey CAMHS

Led on the Think Family DfE Integrated Intervention programme


Work with healthy Schools re: Young Carers Awareness


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Further development of FYI (Fun Youth Involvement) CAMHS children and young people advisory group

MYA and FYI PARTICIPATION AND STAKEHOLDER ENGAGEMENT

The involvement of all stakeholders in the design, development and evaluation of CAMHS in Liverpool is extremely important. Key to this are children, young people and families.

The CAMHS partnership Board and commissioning group ensure participation of children, young people and families at both the provider and commissioner level.


Development of Quality Award for participation (VIP)

MYA and FYI

Development of FYI website FYI

National award received by FYI re: innovation and engagement

FYI

Children and young people involved in local, regional and national conferences

FYI and children and young people from all CAMHS providers

Successful completion of VIP (Voices in Partnership) Award

All CAMHS Providers

A range of films produced to enhance training

FYI and children and young people from all CAMHS providers

Participation Intern programme which gave opportunities for Looked After young people to work in a paid position

Alder Hey CAMHS

A number of children and young people consulted on a range of local, regional and national projects

All CAMHS Providers and Community Development Worker (CDW)

Trained 10 young mentors to co-facilitate the ‘Talk don’t Walk’ project

YPAS

Young People involved in recruitment process of new staff

All CAMHS Providers

A range of experience of service questionnaires used including Implementation of Puzzledout.com – experience of service online tool.

All CAMHS Providers

Children, young people and families involved in care planning process

All CAMHS Providers

Developed and delivered specific training to schools around engagement with BME parents

CDW

A number of children and young people groups operating within individual organizations

All CAMHS Providers

Links and joint working with existing parent/carer networks including the development and delivery of events

MYA



Participation Leads and Champions identified within each organization

All CAMHS Providers

Children and young people involved in organisational promotional materials

All CAMHS Providers

The Keeping the Family in Mind (KFIM) Role has contributed to supporting the Think Family sustainable strategic change


WHOLE FAMILY

CAMHS are part of the ‘Think Family’ agenda in Liverpool and have been part of many developments in this area. All our providers are required to work within the ‘Think Family’ model and framework understanding the importance of working systemically.


The learning and positive outcomes from the SCIE Think Family Implementation has been highlighted nationally as best practice


Developing the pathway between adults and children’s services using the Common Assessment Framework (CAF) and Team Around the Family


KFIM has been instrumental with partners in the Family support Workers Project working within Adult Community Mental Health teams.


Development of a template for a local memorandum of understanding between statutory Directors for children’s and adult social services


Delivery of systemic family therapy/approaches

YPAS, PSS Spinning World and Alder Hey CAMHS

Delivery of a range of parenting programmes

YPAS, Alder Hey CAMHS, ADHD Foundation

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Cultural Competency Training delivered across all CAMHS Providers

CDW and Alder Hey CAMHS

WORKFORCE DEVELOPMENT

We want to ensure our CAMHS workforce is robust and fit for purpose. During the past three years the CAMHS workforce has increased. Most of our CAMHS commissioned services provide training within their specialist area in order to raise awareness and improve the skills of those working at a lower threshold. Those professionals working within CAMHS are also accessing further training to improve their skills.


Multi-agency training programme across children and adult services as part of LSCB


New Mental Health Practitioner posts appointed as identified through restructure

Alder Hey CAMHS

Care Aims training rolled out across all CAMHS Providers

All CAMHS providers

CAMHS providers attended refreshed CAF training

All CAMHS providers

A range of CAMHS Practitioners from across CAMHS providers have attended external training to support their continual professional development

All CAMHS providers

Development and delivery of a range of specific themed training courses to the universal workforce, LAC, Young Carers, Refugee and Asylum Seekers, Self Harm, depression, Bereavement, ADHD etc

All CAMHS providers

Development and delivery of CAMHS Masterclass to outline Comprehensive CAMHS Pathway and making an appropriate referral

All CAMHS providers

Continuation of general mental health awareness MBM

MYA and FYI

Development of Training Needs Analysis MYA and Alder Hey CAMHS

Delivery of CAF and Think Family training across the children’s and adults workforce


The re-designed Message in a Bottle is being disseminated across the adult mental health teams to ensure they use the tool and support whole family working in their care co-ordinator and in-patient roles




Care Programme Approach (CPA) now in use across Specialist CAMHS

Alder Hey CAMHS COMPLEX NEEDS

Systems and services have been developed during the last 3 years to ensure those children and young people with more complex needs and their families receive appropriate mental health care and support.


Local agreements have been made with adult A&E services to scan our CPA documentation onto their system to ensure that the care plan is adhered to in young people over 16 presents in crisis

Alder Hey CAMHS

Regular Transition of Care (TOC) meetings with Merseycare to review possible service developments, best meet the needs of 16-18 year olds with complex mental health needs


DBT (Dialectical Behaviour Treatment) training completed by 4 clinicians at Alder Hey. DBT skills group running for 14-18 year olds accessing Specialist CAMHS

Alder Hey CAMHS

Consultations sessions offered to Tier 4 Inpatient unit staff (Young Persons Centre) from specialist CAMHS to ensure that pathways for young people on admission and discharge are needs led and easy to navigate

Alder Hey CAMHS

High Intensity service for LAC with high risk and complex needs to help prevent placement disruption. 6 out of 7 placements were stabilized plus reducing needs for out of city specialist placements

Alder Hey CAMHS

Reduction in Tier 4 placements All CAMHS Providers

Specialist Trauma service for refugee and asylum seeking children young people and their families

PSS Spinning World

Pilot of family group meetings which has reduced the negative impact of the caring role on the child and young person.


Review commenced of ASD pathway and neurodevelopmental needs

Commissioners and appropriate providers

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Commenced session by session Routine Outcome Measures

YPAS, Alder Hey CAMHS and ADHD Foundation

OUTCOME MONITORING

During the past three years CAMHS providers have improved their systems to collect better and more meaningful outcomes as well as outputs.

We want to ensure that we implement outcome based commissioning and work in partnership with providers in doing so


CAMHS Partnership became members of CORC (CAMHS outcome Research consortium) which resulted in all commissioned CAMHS Providers delivering interventions to children and young people inputting outcome measures through this system

CAMHS Partnership

Annual CORC reports received outlining 90% positive outcomes those children and young people accessing services

Alder hey CAMHS, YPAS, PSS Spinning World and ADHD Foundation

Use of a range of validated outcome measures

All CAMHS providers

Development of IMT systems to ensure robust data collection

Alder Hey CAMHS, YPAS and ADHD Foundation

Local input to national PBR (Payment By Results) developments

Alder Hey and VCS CAMHS

Outcomes from CORC and Returns:- 90% improvement in the mental

health of those accessing services- 90% service satisfaction of those

accessing services- Reduction in tier 3 referrals- Reduction in tier 4 referrals

All services

Continuation of CAMHS pooled budget LPCT/LCCG and LCC JOINT COMMISSIONING

Since 2003 LPCT/LCCG and LCC have worked in partnership to jointly commission CAMHS in Liverpool in order to ensure a comprehensive CAMHS for all children and young people and their families is developed

During the last 3 years the commissioning process has become more transparent and structured.


Schools contribution to CAMHS pooled budget

Schools

Commissioning new ways of working/practice (Care aims)

LPCT/LCC/schools

Development of an outcome based comprehensive CAMHS pathway

LPCT/LCC/schools

Nationally recognised model LPCT/LCC/schools


Documents

CHILDREN AND YOUNG PEOPLES’ MENTAL HEALTH AND … · WELLBEING STRATEGY 2014-2017 Making the Mental Health and Emotional Wellbeing ... Child health and wellbeing is closely related